Complications of Frontal Sinus Fractures

Abstract

Frontal sinus fracture represents 5 to 12% of all maxillofacial fractures. Because of the anatomic position of the frontal sinus and the enormous amount of force required to create a fracture in this area, these injuries are often devastating and associated with other trauma. Associated injuries include skull base, intracranial, ophthalmologic, and maxillofacial. Complications should be categorized to address these four areas as well as the skin-soft tissue envelope, muscle, and bone. Other variables that should be examined are age of the patient, gender, mechanism of injury, fracture pattern, method of repair, and associated injuries. Management of frontal sinus fractures is so controversial that the indications, timing, method of repair, and surveillance remain disputable among several surgical specialties. The one universal truth that is agreed upon is that all patients undergoing reconstructive surgery of the frontal sinus have a lifelong risk for delayed complications. It is hoped that when patients do experience the first symptoms of a complication, they seek immediate medical attention and avoid potentially life-threatening situations and the need for crippling or disfiguring surgery. The best way to facilitate this is through long-term follow-up and routine surveillance.

Managing the Frontal Sinus in the Endoscopic Age: Has the Endoscope Changed the Algorithm?

“…[1][2][3][4][5][6][7] The controversy persists because these injuries have a propensity to develop significant delayed complications, sometimes years after an excellent reduction with a good cosmetic repair has been accomplished. 8 Whether or not to explore rather than observe a nondisplaced or minimally displaced fracture, and what procedure to perform if exploration is considered remain controversial. Furthermore, how severe must displacement/disruption be to require exploration and/or repair, whether or not a transient cerebrospinal fluid (CSF) leak requires exploration and/or repair, and whether or not the sinus should be obliterated and/or cranialized also remain areas of great controversy in the literature and among experienced surgeons.…”

Contralateral Orbital Mucocele as a Complication of Unilateral Nasal Polyposis

“…Other contributing factors include mucosal atopy, polyposis, neoplasia, and chronic rhinosinusitis. A history of trauma is occasionally elicited in patients with a sinus mucocele, often years or decades after the injury [3]. Mucocele that occurs in the frontal sinus may erode inferiorly into the orbit, producing orbital edema, diplopia, ptosis, enophthalmos, hypoglobus, or retro-orbital pain [4].…”

Textbook of Plastic and Reconstructive Surgery

“…Mucosa should be fastidiously removed, including from the vascular crypts of Breschet. Nasal communication should be eliminated and the sinus filled with graft tissue (Metzinger and Metzinger, 2009). This approach has been challenged based on the current understanding of osteoneogenesis.…”